THE PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN THE INTENSIVE CARE UNIT--OUR EXPERIENCE/PERKUTANA DILATACIONA TRAHEOSTOMIJA U JEDINICI INTENZIVNE TERAPIJE--NASE ISKUSTVO

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient's neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy--Ciaglia Single Dilatator method with the TRACOE[R] experc Set vario which includes spiral reinforced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.Key words: Intubation, Intratracheal; Tracheostomy; Critical Illness; Intensive Care Units; Airway Management; Bronchoscopy; Ultrasonography; Respiration, ArtificialPerkutana traheostomija je najcesce izvodena procedura kod bolesnika u jedinici intenzivne terapije. Tehnika izvodenja perkutane dilatacione traheostomije sastoji se od plasiranja trahealne kanile tupom dilatacijom prednjeg zida vrata, pomocu Seldingerovog vodica. Od kada je u rutinsku klinicku praksu u KlinicKi centar Vojvodine uvedena tehnika perkutane dilatacione traheostomije, napravljen je protokol za njeno izvodenje. Ovaj protokol sadrzi sledece postupke: 1. postavljanje indikacije za izvodenje intervencije, kontraindikacije za izvodenje intervencije i vreme